Association between alopecia areata, anxiety, and depression: A systematic review and meta-analysis

Background: To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression.Objective: We sought to analyze the existing literature to examine the association between alopecia areata, anxiety, and depression. Methods: We extracted literature from 4 databases including MEDLINE, Embase, PsychINFO, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (ie, PRISMA) reporting guidelines to finalize a list of relevant articles to be included in our systematic review and meta-analysis. There were no restrictions placed on publication year or age of participants.Results: Eight studies that included 6010 patients with AA and 20 961 control individuals were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies showed a positive association with anxiety (pooled odds ratio, 2.50; 95% confidence interval, 1.54-4.06) and depression (pooled odds ratio, 2.71; 95% confidence interval, 1.52-4.82).Limitations: Publication bias may be a limitation of the study. Conclusion: This study suggests that patients with AA are at higher risk of both anxiety and depression. Health care professionals must be cognizant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated. ( J Am Acad Dermatol 2023;88:1040-50.)